jj3044 wrote:Is having the first scenario better, only discovering 90,000 cases and having a lot of cases going undiagnosed? Or, is the second scenario better, even though some have to wait longer than 4 weeks?

That is pretty much the conservative playbook. Let people die because of undetected and preventable illnesses, and claim the free market is working.

Yes, because this scenario is the conservative playbook.

/sarcasm

The free market does not let people die because of undetected and preventable illnesses. You guys are fucking idiots. Seriously. How someone can be so smart and so fucking stupid at the same time is beyond me.

Your ad hominem arguments, while appropriate given the name of the forum, do nothing to advance the discussion.

It is certainly the case that many people die every year from illnesses that could have been prevented or treated, but were turned away because of insurance company polices precluding things like granting policies to those with pre-existing conditions. That is what happens when there is no government oversight on who can be insured. This is not an opinion. It is a fact, and has been well documented.

jj3044 wrote:Just to play a little devil's advocate here, I have a hypothetical in regards to the Canadian story:

Say today in the current system we are at 90% capacity in the US from an operating room perspective, meaning there are some occasional openings, because we are catching and operating on about 90,000 cases of cancer (and total capacity is to operate on 100,000 cases within 4-weeks of discovery).

Now say that due to Obamacare, more people get preventive services, as the law is designed to do, and detect cancers in early stages. Say that it means that 120,000 cases are discovered after the law. The current capacity is 100,000 cases per year, and that is how many are serviced within 4 weeks. The other 20,000 will have to wait longer for surgery, but have at least had their cancer diagnosed and have started other treatments.

Is having the first scenario better, only discovering 90,000 cases and having a lot of cases going undiagnosed? Or, is the second scenario better, even though some have to wait longer than 4 weeks?

Let's assume that everything in your scenario is factual as to what will happen under Obamacare. Now, let's factor in the reality that because of the massive amount of payments to doctors that will be cut (the largest chunk of the cuts to Medicare that is supposed to be used to pay for Obamacare), enough doctors drop out of the practice to cause the total capacity of cancer operations to drop from 100,000 to 75,000 per month (a very plausible scenario given the number of doctors polled saying they will quit accepting new patients or will even quit such practices). So even though Obamacare might diagnose more people early, even fewer people than before will be able to receive treatments.

I wouldn't say it is a part of the conservative playbook, but its certainly a part of someone's playbook:

President Nixon: Say that I—I—I'd tell him I have doubts about it, but I think that it's, uh, now let me ask you, now you give me your judgment. You know I'm not to keen on any of these damn medical programs. Ehrlichman: This, uh, let me, let me tell you how I am— President Nixon: [Unclear.] Ehrlichman: This—this is a— President Nixon: I don't [unclear]— Ehrlichman: —private enterprise one. President Nixon: Well, that appeals to me. Ehrlichman: Edgar Kaiser is running his Permanente deal for profit. And the reason that he can—the reason he can do it—I had Edgar Kaiser come in—talk to me about this and I went into it in some depth. All the incentives are toward less medical care, because— President Nixon: [Unclear.] Ehrlichman: —the less care they give them, the more money they make. President Nixon: Fine. [Unclear.] Ehrlichman: [Unclear] and the incentives run the right way. President Nixon: Not bad.

Chariot of Fire wrote:As for GreecePwns.....yeah, what? A massive debt. Get a job you slacker.

Viceroy wrote:[The Biblical creation story] was written in a time when there was no way to confirm this fact and is in fact a statement of the facts.

jj3044 wrote:Is having the first scenario better, only discovering 90,000 cases and having a lot of cases going undiagnosed? Or, is the second scenario better, even though some have to wait longer than 4 weeks?

That is pretty much the conservative playbook. Let people die because of undetected and preventable illnesses, and claim the free market is working.

You're shooting at the wrong target there bucko. Did you see the bit where our resident fiscally conservative tax laywer said he'd prefer socialised HC over the incumberant?

This isnt a debate about left vs right; this is a debate around what makes sense and what is retarded.

jj3044 wrote:Is having the first scenario better, only discovering 90,000 cases and having a lot of cases going undiagnosed? Or, is the second scenario better, even though some have to wait longer than 4 weeks?

That is pretty much the conservative playbook. Let people die because of undetected and preventable illnesses, and claim the free market is working.

You're shooting at the wrong target there bucko. Did you see the bit where our resident fiscally conservative tax laywer said he'd prefer socialised HC over the incumberant?

This isnt a debate about left vs right; this is a debate around what makes sense and what is retarded.

I'm not directly discussing Obamacare either. I believe that socialized healthcare ought to be the best system from an ethical perspective; whether it is the more efficient system in terms of generating the greatest good for the greatest number is not something I have the answer to.

Nevertheless, I wholly support a change from the status quo of 2009, where a large number of illnesses could be prevented by giving people access to health insurance. The fact that we couldn't achieve, for example, the single-payer system is not a reason to just abandon all hope of improving access to health care. Anyone who insists on either socialized healthcare or nothing may have a nice theoretical argument, but I can't see how it's morally justified to let people die from preventable illnesses because you didn't like the compromise we ended up getting.

My concern as a left leaning observer is that Obamas plans for HC while look like theyre heading in the right direction is going to have far too many of the unintended consequences BBS harps on about for it to be anything other than worse.

Having said that; I would probably suggest that Obamas plan is about as "left" as you could hope to pull off considering the political landscape in the US. (full socialisation is not possible; see NS/PS for proof - that is they would dig their heels in and [successfullly] block any kind of socialisation).

Lootifer wrote:My concern as a left leaning observer is that Obamas plans for HC while look like theyre heading in the right direction is going to have far too many of the unintended consequences BBS harps on about for it to be anything other than worse.

I agree that the unintended consequences are probably incredibly hard to evaluate for a policy as large and sweeping as this. That being said, unintended consequences aren't necessarily bad, and I feel as though we are morally obliged to not sit and do nothing while the unregulated insurance market permits people to die of diseases that can be treated easily using modern medicine. It is possible that we will end up with a worse medical system as a result, but it is also possible that we will end up with a better one. Without some systematic evaluation of where such consequences might lie, I do not feel as though they are a reason for inaction. Not when we're talking about thousands of cases of where human life hangs in the balance.

Lootifer wrote:My concern as a left leaning observer is that Obamas plans for HC while look like theyre heading in the right direction is going to have far too many of the unintended consequences BBS harps on about for it to be anything other than worse.

I agree that the unintended consequences are probably incredibly hard to evaluate for a policy as large and sweeping as this. That being said, unintended consequences aren't necessarily bad, and I feel as though we are morally obliged to not sit and do nothing while the unregulated insurance market permits people to die of diseases that can be treated easily using modern medicine. It is possible that we will end up with a worse medical system as a result, but it is also possible that we will end up with a better one. Without some systematic evaluation of where such consequences might lie, I do not feel as though they are a reason for inaction. Not when we're talking about thousands of cases of where human life hangs in the balance.

Mets sums up my position nicely as well... while I am sure there will be some unintended negative consequences, I am hoping that the intended positive outcomes far outweigh the negative. Considering the old system is/was unsustainable, the only unacceptable course, in my opinion, was inaction.

PLAYER57832 wrote: Illegally refusing coverage is perhaps rare, though you have to get technical there because Blue Cross (other than highmark, higher end Blue Cross plans) has a way of stone-walling and delaying approvals in such a manner that they are not technically denying coverage, but... they might as well be denying it.

These things all very much DID change. And far from what the Republicans are trying to claim, most doctors and hospitals are very happy about the healthcare reform act.

BUT.. it is far from perfect. We need true universal coverage.

Blue Cross isn't the only company who stonewalls and delays approvals. You're right, most doctors and hospitals are happy about the Affordable Care Act because when there was no one to pay, it was the doctors and hospitals who got shafted.

Personal experience: Auto accident. I had auto coverage, the guy who hit me had auto coverage as well.

The combined total coverage of both our plans did not cover my bills, plus the insurances were arguing about things. I had to hire a personal injury attorney to help figure out who would pay.

Fortunately, I also had medical coverage under a separate policy so was able to get treatment while things got ironed out.

Here's what the ironing did: The attorneys received a cut. My separate medical policy got reimbursed. Most of the doctors got 20% of what it cost to treat me (because the money was eaten up by the attorney cuts first, the reimbursement of the separate medical insurance policy second, the doctors last.) I got stuck with the bills, which I could not afford so had to bankrupt, so the doctors who got 20% were fortunate.

I understood the attorney cut from a business sense, although I detested that I had to go that route for a clear-cut claim. I did not understand why my other insurance got the second cut. The money from the auto insurances did not cover all the medical bills, but it was medical bills, so shouldn't my medical insurance have to pay the medical bills? If I'd fallen at home, they would have had to pay (anything over deductibles etc which I had already paid.) So why did they get reimbursed next?

I think it should have been: treatment paid by auto companies without having to hire attorneys to force it; leftover bills that were covered under my medical insurance paid for by the insurance. Not, "everyone gets paid but the docs who did the work."

The Affordable Care Act tries to ensure that the docs who do the work get paid some reasonable-and-customary amount for the work they did. That's fair.

jj3044 wrote:Is having the first scenario better, only discovering 90,000 cases and having a lot of cases going undiagnosed? Or, is the second scenario better, even though some have to wait longer than 4 weeks?

That is pretty much the conservative playbook. Let people die because of undetected and preventable illnesses, and claim the free market is working.

Yes, because this scenario is the conservative playbook.

/sarcasm

The free market does not let people die because of undetected and preventable illnesses. You guys are fucking idiots. Seriously. How someone can be so smart and so fucking stupid at the same time is beyond me.

Your ad hominem arguments, while appropriate given the name of the forum, do nothing to advance the discussion.

It is certainly the case that many people die every year from illnesses that could have been prevented or treated, but were turned away because of insurance company polices precluding things like granting policies to those with pre-existing conditions. That is what happens when there is no government oversight on who can be insured. This is not an opinion. It is a fact, and has been well documented.

It's not fact. Sorry little buddy. When you make up some pretend land where health insurance and healthcare exist in a free market, you can't point to lack of access to health insurance and preventative medicine as the failure of the free market health insurance or healthcare system.

I mean, if I went around saying that Conquer Club was a horrible website for sports gaming, people would look at me weird.

thegreekdog wrote:It's not fact. Sorry little buddy. When you make up some pretend land where health insurance and healthcare exist in a free market, you can't point to lack of access to health insurance and preventative medicine as the failure of the free market health insurance or healthcare system.

I didn't say this had anything to do with a completely free market. My post made it quite clear that I was citing a typical conservative justification of the current system, not my personal belief. The fact is, there was regulation of the insurance industry before Obamacare. But it was done on a state-by-state basis, and did not protect the people who most needed to be protected. The whole point of my post is that when there is no regulation regarding individual access to healthcare, which would be the default free market principle, people who need health insurance do not get it. That is a failure, if we believe that health insurance for all is a desirable goal.

thegreekdog wrote:It's not fact. Sorry little buddy. When you make up some pretend land where health insurance and healthcare exist in a free market, you can't point to lack of access to health insurance and preventative medicine as the failure of the free market health insurance or healthcare system.

I didn't say this had anything to do with a completely free market. My post made it quite clear that I was citing a typical conservative justification of the current system, not my personal belief. The fact is, there was regulation of the insurance industry before Obamacare. But it was done on a state-by-state basis, and did not protect the people who most needed to be protected. The whole point of my post is that when there is no regulation regarding individual access to healthcare, which would be the default free market principle, people who need health insurance do not get it. That is a failure, if we believe that health insurance for all is a desirable goal.

How do you know?

Unfortunately, health insurance is seen to be the solution to healthcare woes, when it is probably more of a problem. And yeah, there are the arguments that doctors getting paid in pumpkin bread or not getting paid at all won't work in our hustle bustle, technologically advanced world. But health insurance is a big business so won't go back to that.

thegreekdog wrote:It's not fact. Sorry little buddy. When you make up some pretend land where health insurance and healthcare exist in a free market, you can't point to lack of access to health insurance and preventative medicine as the failure of the free market health insurance or healthcare system.

I didn't say this had anything to do with a completely free market. My post made it quite clear that I was citing a typical conservative justification of the current system, not my personal belief. The fact is, there was regulation of the insurance industry before Obamacare. But it was done on a state-by-state basis, and did not protect the people who most needed to be protected. The whole point of my post is that when there is no regulation regarding individual access to healthcare, which would be the default free market principle, people who need health insurance do not get it. That is a failure, if we believe that health insurance for all is a desirable goal.

How do you know?

I know because before the ACA, there was essentially no regulation preventing insurance companies from excluding individuals from coverage, and insurance companies did in fact exclude millions from coverage. The free market approach to this problem was the status quo before the ACA. Sure, there were plenty of other regulations on the industry, such as requiring them to retain enough money to actually pay out on claims, but this was the main one that the ACA was aiming to rectify.

Unfortunately, health insurance is seen to be the solution to healthcare woes, when it is probably more of a problem. And yeah, there are the arguments that doctors getting paid in pumpkin bread or not getting paid at all won't work in our hustle bustle, technologically advanced world. But health insurance is a big business so won't go back to that.

Health insurance is suboptimal for both sides, obviously. From a socialist point of view, insurance doesn't get at the root problem of why our health care system is inefficient and serves to exclude the poor. From a conservative point of view, we are now putting extreme regulation on the side of an industry that was previously unregulated. But that's the nature of political compromise. For me, the main point is that more people now have access to basic medical care. That has always been my stake in Obamacare. I'm really ok with accepting a suboptimal solution to this problem on economic terms if the alternative is no solution.

Metsfanmax wrote:I know because before the ACA, there was essentially no regulation preventing insurance companies from excluding individuals from coverage, and insurance companies did in fact exclude millions from coverage. The free market approach to this problem was the status quo before the ACA. Sure, there were plenty of other regulations on the industry, such as requiring them to retain enough money to actually pay out on claims, but this was the main one that the ACA was aiming to rectify.

There is no way that you can demonstrate to me that, prior to the Affordable Care Act, health care and health insurance were part of a free market system. You've identified a problem with health insurance: the exclusion of individuals from coverage. Two thoughts come to mind. First, and less important, health insurance providers are rarely engaged in fair competition. Second, and more important, why do people need health insurance in the first place? Healthcare is expensive, but why is healthcare so expensive? Why is it more expensive now than it was one hundred years ago? One of the least talked about, but most imporant, criticisms of the Affordable Care Act is that it does not solve the problem of healthcare costs and the reason for rising healthcare costs.

The easiest solution in the short term, politically and otherwise, to the problem of making sure people with preexisting conditions can get healthcare is to make sure they get affordable health insurance, which is ostensibly what the Affordable Care Act does (I'm not sure it makes healthcare affordable, so it may not do that). In my mind, the more effective solution, although much more difficult in the short term, is reduce the cost of healthcare itself.

Metsfanmax wrote:Health insurance is suboptimal for both sides, obviously. From a socialist point of view, insurance doesn't get at the root problem of why our health care system is inefficient and serves to exclude the poor. From a conservative point of view, we are now putting extreme regulation on the side of an industry that was previously unregulated. But that's the nature of political compromise. For me, the main point is that more people now have access to basic medical care. That has always been my stake in Obamacare. I'm really ok with accepting a suboptimal solution to this problem on economic terms if the alternative is no solution.

How many more people have access to basic medical care that did not have access to basic medical care prior to the passage of the Affordable Care Act? How much more, incrementally, will the Affordable Care Act cost? These are the two questions that must be asked that people who support and don't support the Affordable Care Act do not ask.

Here are the people that were uninsured prior to the passage of the Affordable Care Act:

- Illegal immigrants (8 million)- Citizens not enrolled in Medicaid despite being eligible- Citizens opting not to be insured (mostly young people)- Citizens who live in states that opt out of Medicaid expansion

These are hardly wide swaths of people, with the exception of illegal immigrants and young people. So, in my opinion, you're accepting that a number of people, those indicated above, will now be insured and that is your reason for supporting the Affordable Care Act.

In supporting the Affordable Care Act, you are also now supporting government (read tax dollar) support of others' purchase of health insurance who could previously afford health insurance but will now choose, or be forced to choose by their employers, to purchase health insurance through exchanges where the price is not regulated. To me, this is worse than status quo, especially when a small fix to status quo, for example making Medicaid available to all of those listed above, would have cost less money. As a final word, the Affordable Care Act is very similar to health care fixes put forward by Republicans during the Clinton administration, which begs the question as whether this is an effective solution to an existing problem or an ineffective corporate boondoggle to insurance companies.

i'm sure there is enough money in our govt currently to pay for free healthcare for all. if they could just work on eliminating waste, instead of devising new ways to tax workers.

I would have understood actual socialized healthcare, where hospitals and healthcare generally, are run by the government (similar to the military or the post office). I would not have agreed with it, but it would make more sense than the Affordable Care Act in doing something to solve the problem of the high cost of healthcare.

thegreekdog wrote:There is no way that you can demonstrate to me that, prior to the Affordable Care Act, health care and health insurance were part of a free market system.

I wasn't arguing that they were. I don't know why you're hung up on this point. I said that this particular facet of the health insurance industry was not regulated. I then went on to explicitly state that the health insurance industry is not, in general, a free market system. So, drop it.

You've identified a problem with health insurance: the exclusion of individuals from coverage. Two thoughts come to mind. First, and less important, health insurance providers are rarely engaged in fair competition. Second, and more important, why do people need health insurance in the first place? Healthcare is expensive, but why is healthcare so expensive? Why is it more expensive now than it was one hundred years ago? One of the least talked about, but most imporant, criticisms of the Affordable Care Act is that it does not solve the problem of healthcare costs and the reason for rising healthcare costs.

The issue of health care costs is indeed important but it doesn't actually address the issue of the uninsured, except perhaps tangentially. We do live in a society where a substantial portion of the population cannot afford or is refused access to insurance. Ensuring that they get insurance does not have to be mutually exclusive with decreasing healthcare costs overall. Calling this a criticism of the ACA is a red herring that distracts from the main issue rather than coming up with ways to solve it.

The easiest solution in the short term, politically and otherwise, to the problem of making sure people with preexisting conditions can get healthcare is to make sure they get affordable health insurance, which is ostensibly what the Affordable Care Act does (I'm not sure it makes healthcare affordable, so it may not do that). In my mind, the more effective solution, although much more difficult in the short term, is reduce the cost of healthcare itself.

I agree, and basically everyone looking at the problem agrees. For the short term, government subsidies are what are needed to make sure that most people are insured. The ACA is surely a bandage and not a full scale surgical operation, but that doesn't make it a bad idea. Furthermore, it's not clear whether it's government action that will ultimately be able to lower healthcare costs, is it?

How many more people have access to basic medical care that did not have access to basic medical care prior to the passage of the Affordable Care Act? How much more, incrementally, will the Affordable Care Act cost? These are the two questions that must be asked that people who support and don't support the Affordable Care Act do not ask.

I do not know why you suggest this. Perhaps the most important justification for the law during its formative stages was the raw number of uninsured Americans, and it has been made clear (e.g., analysis by the CBO) that the ACA is expected to insure about 30 million people over the next several years, which (besides being a rather large number) is the majority of the uninsured. 50 million uninsured is very clearly a "wide swath" of the population. It's possible that there are some supporters that do not know of this analysis, but that does say anything about the value of the legislation.

In supporting the Affordable Care Act, you are also now supporting government (read tax dollar) support of others' purchase of health insurance who could previously afford health insurance but will now choose, or be forced to choose by their employers, to purchase health insurance through exchanges where the price is not regulated.

There are strict regulations on the plan pricing on the health insurance exchanges. Furthermore, the establishment of the tier system for health care plans is argued (by some) to possibly decreases prices. Even if they can't do that, at least the prices are very well managed by the government. Furthermore, the health insurance exchanges generally result in better competition, and I would expect a fiscal conservative to approve of this.

As a final word, the Affordable Care Act is very similar to health care fixes put forward by Republicans during the Clinton administration, which begs the question as whether this is an effective solution to an existing problem or an ineffective corporate boondoggle to insurance companies.

Yes, and here again Republicans in Congress precluded the much more radical possibilities that could have truly overhauled the healthcare system. They're obviously not completely to blame, but they did a pretty good job of throwing a wrench in the works.

Metsfanmax wrote:The whole point of my post is that when there is no regulation regarding individual access to healthcare, which would be the default free market principle, people who need health insurance do not get it. That is a failure, if we believe that health insurance for all is a desirable goal.

Metsfanmax wrote:I wasn't arguing that they were. I don't know why you're hung up on this point. I said that this particular facet of the health insurance industry was not regulated. I then went on to explicitly state that the health insurance industry is not, in general, a free market system. So, drop it.

I cannot reconcile these two statements, so I probably can't drop it.

Metsfanmax wrote:The issue of health care costs is indeed important but it doesn't actually address the issue of the uninsured, except perhaps tangentially. We do live in a society where a substantial portion of the population cannot afford or is refused access to insurance. Ensuring that they get insurance does not have to be mutually exclusive with decreasing healthcare costs overall. Calling this a criticism of the ACA is a red herring that distracts from the main issue rather than coming up with ways to solve it.

The stated purpose of allowing people access to health insurance was to ensure they had access to healthcare. People that do not have insurance did have access to healthcare prior to the Affordable Care Act. So the stated purpose of the Affordable Care Act is the actual red herring.

Metsfanmax wrote:I agree, and basically everyone looking at the problem agrees. For the short term, government subsidies are what are needed to make sure that most people are insured. The ACA is surely a bandage and not a full scale surgical operation, but that doesn't make it a bad idea. Furthermore, it's not clear whether it's government action that will ultimately be able to lower healthcare costs, is it?

When the bandage costs as much as it does, it becomes a bad idea.

Metsfanmax wrote:I do not know why you suggest this. Perhaps the most important justification for the law during its formative stages was the raw number of uninsured Americans, and it has been made clear (e.g., analysis by the CBO) that the ACA is expected to insure about 30 million people over the next several years, which (besides being a rather large number) is the majority of the uninsured. 50 million uninsured is very clearly a "wide swath" of the population. It's possible that there are some supporters that do not know of this analysis, but that does say anything about the value of the legislation.

I think you're confusing being insured with receiving healthcare (or not being insured with not receiving healthcare).

thegreekdog wrote:Here are the people that were uninsured prior to the passage of the Affordable Care Act:

- Illegal immigrants (8 million)- Citizens not enrolled in Medicaid despite being eligible- Citizens opting not to be insured (mostly young people)- Citizens who live in states that opt out of Medicaid expansion

These are hardly wide swaths of people, with the exception of illegal immigrants and young people.

Whoaaaaaaaaaaah! You're missing a wide swath of adults who could not afford health insurance/care, but did not qualify for Medicaid.Working adults: because their jobs did not provide it, or did not subsidize it, or are so small that the pool is too small to give them a reasonable rate.Non-working adults because they don't get the advantage of any sort of pool at all assuming they have sufficient income from some source or other to purchase health insurance.

My mother, for example, worked for an independent contractor as one of two full-time employees. The rate they would have paid was the same as the rate for an individual, and far higher than the rate of a large construction company that employs thousands of people, for exactly the same policy that provides exactly the same care.

At my local hospital, if you have Humana insurance you/Human will be billed less for a service than an individual walking in to procure the exact same service.

If the service is worth $100 for an individual, why isn't it worth $100 for an insurance company? Is it that individuals and those insured in non-favored pools of insurance were already subsidizing the costs for those in the more-favored pools of insurance?

Nine members of the Wisconsin state legislature say they plan to back a bill to arrest federal officials who try to implement Obamacare.

The state’s Republican Gov. Scott Walker must decide by Friday whether the state will draft a health care exchange plan under Obamacare or surrender the task to the federal government.

“Just because Obama was re-elected does not mean he’s above the Constitution,” Republican state Rep. Chris Kapenga told the Milwaukee Journal-Sentinel.

Of the nine Republicans who advocated arresting federal officials, eight have also said on record that they want to write a law that would permit prosecuting TSA agents who physically search passengers with sexual assault.

Additionally, all nine told a tea party-aligned group that they supported the passing of legislation that would allow people to carry guns without first acquiring a permit, allow people to buy raw or unpasteurized milk, allow people to carry guns without state permits and block state funding for federal Real ID laws that require states to develop more secure driver’s licenses.

Kapenga said that he doesn’t think “right-to-work” laws, which bar private-sector labor contracts from including provisions that require employees to join unions as conditions of employment, will be passed in the upcoming congressional session, even with Republican majorities in the state assembly and senate.

“I very much support right to work, but do I think it’s realistic? No. I don’t think we’ll have the political capital to do it,” Kapenga said.

Republicans were able to pass a bill in the last session allowing people to get permits from the state to carry concealed weapons, ending Wisconsin’s lengthy ban on the practice.

Wisconsin won't create a health insurance exchange, Gov. Scott Walker (R) announced Friday, making it the latest state to reject a key component of President Barack Obama's health care reform law.

Wisconsin was one of the few remaining holdouts until Friday, the original deadline for states to declare whether they would run a health insurance exchange, before an extension to Dec. 14. The exchanges are online marketplaces where uninsured people and small business will shop for coverage and find out if they qualify for financial assistance or Medicaid benefits beginning in 2014. More than half of states have declared they would leave the operation of the exchanges to the federal government, or partner with federal authorities rather than take charge themselves, as the law intended.

Walker decided to turn the health insurance exchange in his state over to the federal government rather than implement it himself, citing in a letter to Health and Human Services Secretary Kathleen Sebelius his opposition to Obamacare and his belief that states like Wisconsin still wouldn't have enough say over their health care markets even if they manage their own exchanges under federal guidelines.

"No matter which option is chosen, Wisconsin taxpayers will not have meaningful control over the health care policies and services sold to Wisconsin residents," Walker wrote. "If the state option is chosen, however, Wisconsinites face risk from a federal mandate lacking long-term guaranteed funding."

Earlier Friday, Maine Gov. Paul LePage (R) reiterated that his state wouldn't create an exchange. "We are not going to assist in implementation of this bill in its current form," LePage wrote Sebelius. "In the end, a state exchange puts the burden onto the states and the expense onto our taxpayers, without giving the state the authority and flexibility we must have to best meet the needs of the people of Maine.”

Ohio Gov. John Kasich (R) announced later Friday that his state would also not establish its own exchange. "Turning down a state-based health exchange and saying no to federal regulation of Ohio’s health insurance industry and Medicaid eligibility determination is the best approach for Ohio," Kasich's office said in a press release. The announcement conforms with earlier comments made by Lt. Gov. Mary Taylor (R) on Tuesday.

Idaho Gov. C.L. "Butch" Otter (R) said in a press release Friday afternoon that he will postpone a decision on creating a health insurance exchange until the new Dec. 14 deadline. "This extension gives us more time to get answers from [the Department of Health and Human Services] about what the federal requirements will be,” Otter said. “I don’t want us buying a pig in a poke, so with this extension I’m hoping we’ll get answers to the questions and concerns we’re hearing from legislators and the public.” Last month, a working group of Idaho legislators and health care industry representatives appointed by Otter recommended the state run its health exchange rather than let the federal government do so.

New Jersey Gov. Chris Christie (R) told reporters he also would hold off on making a decision, PolitickerNJ reported Friday. “I need answers from the Obama administration,” Christie said at a press conference, according to the website. “I hope they don’t back us into a decision by not giving me an answer.”

In a letter to Sebelius posted online Friday, Florida Gov. Rick Scott (R) requests a meeting with the secretary to "discuss possible solutions for Florida families at your earliest opportunity." Scott has been one of Obamacare's most outspoken critics and spent $5 million of his own money fighting it in Congress, but he has attempted to sound a conciliatory note in recent days. Scott's letter doesn't suggest he's ready to embrace the health care reform law, however.

"I am hopeful it is possible for us to work together to lower costs and improve access and quality," he wrote. "Under the current regulatory requirements and the information we have been provided, however, Florida does not have evidence that a [health insurance] exchange can accomplish these goals."

Another undecided Republican governor, Mary Fallin of Oklahoma, also will wait to take a position on an exchange, the Tulsa World reported Friday. Fallin's office received more than 1,000 constituent phone calls on the issue Thursday, according to the newspaper.

Arizona Gov. Jan Brewer (R) said Thursday she too would postpone an announcement until next month.

Most governors already had declared their positions on health insurance exchanges through official statements or public comments well before Friday. In recent days, a slew of Republican governors including Texas' Rick Perry, Alabama's Robert Bentley, Nebraska's John Heineman, Louisiana's Bobby Jindal and Alaska's Sean Parnell also restated their opposition to state-run health insurance exchanges under federal guidelines. New Mexico Gov. Susana Martinez (R) confirmed Thursday that her state would run its exchange.

A handful of states hadn't made a decision as of Friday, such as Pennsylvania.

Eighteen states and the District of Columbia are likely to have their own exchanges in place by Oct. 1, 2013, when people will begin using them to buy health insurance, according to Avalere Health, a consulting company. The remainder will either let the federal government do the work or collaborate with Health and Human Services, Avalere Health predicts.

thegreekdog wrote:Here are the people that were uninsured prior to the passage of the Affordable Care Act:

- Illegal immigrants (8 million)- Citizens not enrolled in Medicaid despite being eligible- Citizens opting not to be insured (mostly young people)- Citizens who live in states that opt out of Medicaid expansion

These are hardly wide swaths of people, with the exception of illegal immigrants and young people.

Whoaaaaaaaaaaah! You're missing a wide swath of adults who could not afford health insurance/care, but did not qualify for Medicaid.Working adults: because their jobs did not provide it, or did not subsidize it, or are so small that the pool is too small to give them a reasonable rate.Non-working adults because they don't get the advantage of any sort of pool at all assuming they have sufficient income from some source or other to purchase health insurance.

My mother, for example, worked for an independent contractor as one of two full-time employees. The rate they would have paid was the same as the rate for an individual, and far higher than the rate of a large construction company that employs thousands of people, for exactly the same policy that provides exactly the same care.

At my local hospital, if you have Humana insurance you/Human will be billed less for a service than an individual walking in to procure the exact same service.

If the service is worth $100 for an individual, why isn't it worth $100 for an insurance company? Is it that individuals and those insured in non-favored pools of insurance were already subsidizing the costs for those in the more-favored pools of insurance?

Sounds like perfect reasons for getting rid of employer-paid insurance (which the government caused) instead of proving to a government-run system. Besides, who decides what a "reasonable rate" is? The government that doesn't even pay the full cost of treating Medicare patients and will cut it even further under Obamacare?

thegreekdog wrote:Here are the people that were uninsured prior to the passage of the Affordable Care Act:

- Illegal immigrants (8 million)- Citizens not enrolled in Medicaid despite being eligible- Citizens opting not to be insured (mostly young people)- Citizens who live in states that opt out of Medicaid expansion

These are hardly wide swaths of people, with the exception of illegal immigrants and young people.

Whoaaaaaaaaaaah! You're missing a wide swath of adults who could not afford health insurance/care, but did not qualify for Medicaid.Working adults: because their jobs did not provide it, or did not subsidize it, or are so small that the pool is too small to give them a reasonable rate.Non-working adults because they don't get the advantage of any sort of pool at all assuming they have sufficient income from some source or other to purchase health insurance.

My mother, for example, worked for an independent contractor as one of two full-time employees. The rate they would have paid was the same as the rate for an individual, and far higher than the rate of a large construction company that employs thousands of people, for exactly the same policy that provides exactly the same care.

At my local hospital, if you have Humana insurance you/Human will be billed less for a service than an individual walking in to procure the exact same service.

If the service is worth $100 for an individual, why isn't it worth $100 for an insurance company? Is it that individuals and those insured in non-favored pools of insurance were already subsidizing the costs for those in the more-favored pools of insurance?

It's around 50 million people prior to the act (specifically 2010), if my Google-fu is working correctly, TGD.

It boils down to this, really: if you believe a free market health insurance system will be "better" (which is defined using a mix of three categories: # of people insured, quality of care for the average citizen and spending), then the burden of proof is on you to prove so. This is mostly because there hasn't ever truly been a fully free market health insurance system in an industrialized country.

The pre-2010 US system does come closest to free market when compared to every other industrialized nation and their systems in the past half century. And in all three of the above categories it empirically performs worse than its French, Dutch and comparable counterparts. The usual retort is that quality of care here is better than other nations and that rich foreigners come here for care instead of staying in their own country. My response to that is that the aim of a health insurance system, be it free market or employer-provided or government-owned or whatever, is to provide quality care for as many people as possible, not only a select few. The quality of care argument falls on deaf ears when you compared the type of care the average American citizen gets to other countries.

Another popular retort is that the other countries' diets are better, therefore they naturally should be spending less per capita on health insurance. Well, not 3 or 4 times less, and that's even true for the fattest country in Europe (Greece). Sure, diets play a big role in the deteriorating health of America, but not nearly that big a role.

So, libertarians, ball is in your court. If you don't count pre-2010 US as a free market system, please provide a relevant example that is and prove that it empirically performed better (or would perform better in the current circumstances). If there is no such example, please argue why one would perform better than the current systems used by certain countries.

Chariot of Fire wrote:As for GreecePwns.....yeah, what? A massive debt. Get a job you slacker.

Viceroy wrote:[The Biblical creation story] was written in a time when there was no way to confirm this fact and is in fact a statement of the facts.

GreecePwns wrote:if you believe a free market health insurance system will be "better" (which is defined using a mix of three categories: # of people insured, quality of care for the average citizen and spending), then the burden of proof is on you to prove so. This is mostly because there hasn't ever truly been a fully free market health insurance system in an industrialized country.

I don't agree with this for two reasons. First, I cannot possibly prove something is better if it has never existed. Second, there is nothing to be incrementally done by the government in a free market healthcare system (i.e. I'm not asking for money from the government). So, unfortunately, I cannot look at some point in history where our healthcare was a free market system because it does not exist. The closest we can come is to the time before health insurance where doctors made housecalls and apple pie and stuff. So, I have to use common sense and some financial acumen.

The history of health insurance is a fascinating one. Health insurance was not invented until the late 19th century and did not evolve into what we know today until the latter part of the 20th century. In any event, health insurance is a concept that begets rising costs. If a company will pay for my medical care, why would my doctor not charge as much as he/she could possibly get paid? And if the government is backing the health insurance, would not costs skyrocket?

Healthcare costs increased substantially, as a percentage of GDP from 1968 to 2008. Why? I'm sure the growing number of obese people and increases in the average age of our population had much to do with it. But one would think technological advancement would breed less need to spend money on healthcare. There are a number of studies showing what drives healthcare costs in the US. Such factors include increase utiliation of health insurance created by increased consumer demand (which will only increase now that we have "free" health insurance), new treatments, and more intensive diagnostic screening. Other researchers indicated that healthcare providers are rewarded for treating and testing patients rather than curing them. None of these cost factors are helped by the Affordable Care Act.

And your response is going to be "so what, more people are insured." And my response to you is "who cares if people are getting shitty care and it's costing more and more money."

As for the US healthcare industry being "more" free market than other countries' systems and performing worse, my only response is that being less free market than France or the Netherlands does not make it free market. It's like saying Greece is less financially stable than Portugal. Health insurance is highly regulated, true. But that's not where I'm going with this. Where I'm going with this is that there is no incentive for health insurance companies to lower costs because there is no competition. There is no incentive for healthcare providers to lower costs or provide better care because the system, regulated in this fashion by the governments of the vairous states, rewards them for increasing costs. The Affordable Care Act just pours another layer of cement on the problem, making sure that it will be that much harder to provide affordable care to everyone.

One final note - Most people regularly and happily pooh-pooh the concept that anyone can get free medical care. I don't understand the pooh-poohs. From the age of 18 to the age of 25, I did not have health insurance. I regularly received what medical care I desired and for the most part was not charged anything for it. I know there are people that cannot afford health insurance or healthcare, just like I coudn't afford it when I was younger. And I know there are people with preexisting conditions who cannot get health insurance. I have no problem with the government trying to help those people (I would prefer other people help those people without government intervention, which, by the way, already happens at non-profit hospitals). I read the Affordable Care Act and various summaries on the law, and I cannot understand how anyone who can think for themselves thinks this is anything more than a boondoggle for the health insurance industry and something that will, in the long run, greatly hurt healthcare and the fiscal status of the US government to a staggering degree.